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Analysis of transcervical resection of intrauterine adhesions for acquired synechiae
August 1999, Vol. 6, No. 3 Supplement TheJournal of the American Association of Gynecologic Laparoscopists
through the ipsilateral incisions on both sides. The two hammocks were adjusted to hold the vaginal apex in the correct position and tied symmetrically to the edges of the aponeurotic incision. The procedure was successfully completed in all 35 patients without serious complications and no conversions to laparotomy. The women were followed prospectively at 1, 6, and 12 months, and then annually. They responded to a questionnaire during telephone interviews. Objectively, an excellent anatomic result was achieved in 80% of cases (28 patients). Subjectively, 90% of women noted relief of symptoms and improvement in quality of life at last follow-up. Conclusion. This technique was highly effective in treating genital prolapse. 44. Pregnancy after Laparoscopic Myomectomy JB Dubuisson, C Chapron, A Fauconnier, } Deffarges. H6pita[ Baudelocque, Paris, France. Objective. To evaluate pregnancy outcome and risk of uterine rupture after laparoscopic myomectomy (LM). Measurements and Main Results. Among 296 women (age <45 yrs) treated by LM, 98 became pregnant with 100 deliveries ( 145 pregnancies); 58 % delivered vaginally and 42% by cesarean section; 3 uterine ruptures occurred. Only the first rupture (1%) was secondary to LM, another was due to a second operation (laparoscopic-assisted myomectomy) performed elsewhere, and the third to tubouterine implantation. Conclusion. Laparoscopic m y o m e c t o m y requires meticulous technique and excellent repair of the uterine wall. Surgeons must be highly experienced in laparoscopic surgery to limit the risk of uterine rupture. 45. Endometrial Aspiration and Microwave Endometrial Ablation MA El[ard, NC Sharp. Royal United Hospital, Bath, United Kingdom.
Conclusion. Endometrial aspiration is a promising alternative to medical pretreatment, with reduced costs and no side effects, and the ability to obtain an endometrial biopsy specimen. Microwave endometrial ablation can potentially be developed as a one-stop office procedure. 46. Microwave Endometrial Ablation in Women with a Fibroid Uterus MA Ellard, O Hodgson. Royal United Hospital, Bath, United Kingdom. Objective. To describe microwave endometrial ablation (MEA) as an alternative to hysterectomy in treatment of myomas. Measurements and Main Results. Two hundred sixtysix women underwent MEA and completed a minimum of 36 months of follow-up. Fifty-two (19.5%) had uterine myomas, 12 (23.1%) of which distorted the uterine cavity. Fourteen women (26.9%) had more than one myoma on US scan. Of 52 patients with myomas, 82.7% reported satisfaction at 6 months, with 32.7% reporting amenorrhea. This compares with 87.6% satisfaction and 38.3% amenorrhea 6 months for women without myomas. Of 14 patients who required further surgery, 1 had a myoma distorting the cavity and 3 (21.4%) had more than one myoma. Six (10.7%) women went on to have hysterectomy. Conclusion. After MEA, 88% of patients with myomas avoided hysterectomy. Multiple myomas and those causing slight distortion of the uterine cavity do not adversely affect outcome. 47. Analysis of Transcervical Resection of Intrauterine Adhesions for Acquired Synechiae X Enlan, O Hua, F Limin, D Huelan, M Zhang. Fuxing Hospital, Capital University of Medical Sciences, Beijing, Republic of China. Objective. To assess the efficacy and safety of transcervical resection of adhesions (TCRA). Measurements and Main Results. Among 31 women (age 27-46 yrs), 13 had a history of transcervical resection of the endomyometrium, 15 a history of abortion and curettage, and 3 no history of pathology. Indications for surgery were infertility (12), oligomenorrhea (6), dysmenorrhea (9), and amenorrhea (4). Nine women had HSG and all had hysteroscopy. Two adhesions were classified as grade I, eight grade l-I, five grade III, seven grade IV, seven grade Va, and two grade
Objective. To describe endometrial aspiration as an alternative to medical thinning of endometrium. Measurements and Main Results. Patients underwent endometrial aspiration with a 3-mm uterine curette, and microwave endometrial ablation. Mean operating time was 241 seconds (181 sec with medical pretreatment). Most women (92.3%) were satisfied with menstrual outcome, with 46.1% reporting amenorrhea at 6 months. No patients have had further surgery to date.
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Abstracts
Vb. The TCRA was performed under B scan with or without laparoscopic monitoring. Mean operating time was 22 minutes and bleeding was minimal. Six patients had hematometra expelled. One woman, the major part of whose uterine cavity was occluded, became pregnant and delivered a normal infant weighing 3550 g. One grade Va uterus was perforated and repaired by laparoscopy. Conclusion. TCRA is safe and effective treatment of acquired intrauterine synechiae. Monitoring with B scan and laparoscopy of difficult cases is recommended.
pretreated. Resection was performed in 65% and rollerball in 35%. Ablation was successful in all patients. Glycine absorption was higher with resection than with rollerball (p = 0.05). Fluid absorption correlated with type of procedure (r = 0.32, p = 0.03) but not with procedure time, uterine size, or pretreatment. With follow-up of 14 _+ 2 months, 95% of patients were satisfied; 80% were amenorrheic and 20% hypomenorrheic. Conclusion. Hysteroscopic endometrial ablation is a safe, effective alternative to hysterectomy in women with large uteri.
48. Transcervical Electroresection of Menorrhagia Combined with Severe Medical Disease X Enlan, O Hua, F Limin, O Huelan, M Zhang. Fuxing Hospital, Capital University of Medical Sciences, Beijing, Republic of China.
50. Transcervical Resection of Submucous Fibroid in a Woman with Thoracocyllosis and Severe Anemia ~C Fang, 1C Qi, 2X Enlan, 2D Zhang, IL Qingchun. ~Panjin Maternal and Child Hospital, Liaoning, Republic of China; 2Fuxing Hospital, Beijing, Republic of China.
Objective. To assess the efficacy and safety of transcervical electroresection of benign uterine lesions for the treatment of menorrhagia combined with severe medical disease, that contraindicated hysterectomy. Measurements and Main Results. In 76 women (age 27-63 yrs) with menorrhagia and severe medical disease (hematophathy, renal failure, cardiac disease, diabetes, hypertension, etc.), we performed resection of endomyometrium (53 cases), polyps (2), or myomas (53) under epidural or intravenous anesthesia. Patients reported improvements in menses and anemia. Two patients died of their medical disorder, one of renal disease and one of heart and respiratory failure. Conclusion. Electroresection of endomyometrium, polyps, or myomas in women with menorrhagia combined with severe medical disease is relatively safe and effective compared with hysterectomy.
Objective. To describe the efficacy and safety of transcervical resection of myomas (TCRM) in a woman with menorrhagia thoracocyllosis and severe anemia. Measurements and Main Results. Because of heavy vaginal bleeding for 2 years, the patient's hemoglobin was 4.4 mg/dl. Her uterus was enlarged to 10 weeks. B scan showed an echo-free mass 6.8 cm in diameter in the uterine cavity. Hysteroscopy showed the uterine cavity to be filled with a single large myoma. Under intravenous anesthesia, the submucous myoma was resected into slices with a resectoscope and removed with ring forceps. The procedure took 130 minutes and was performed with B scan monitoring. Blood loss was about 200 ml. The woman reported no further bleeding at 9-month follow-up visit. Conclusion. For patients with severe medical disease, hysteroscopic surgery is preferred over hysterectomy to treat menorrhagia.
49. Hysteroscopic Endometrial Ablation Is an Effective Alternative to Hysterectomy in Women with Large Uteri ~MA Eskandar, <2GA Vilos, 11Tummon, ~FA Aletebi. ~University of Western Ontario; 2St. Joseph's Health Centre, London, Ontario, Canada.
51. The Physics of Microwave Coagulation, Treatment Dynamics, and Preclinical Testing I Feldberg, N Cronin, M Evans. University of Bath Claverton Downs, Bath, United Kingdom.
Objective. To determine the feasibility, safety, and outcome of hysteroscopic endometrial ablation in women with menorrhagia and large uteri. Measurements and Main Results. Forty-two consecutive women (mean _+SD age 46 _+6 yrs) with a uterus larger than 12 weeks (cavity >10 cm) underwent endometrial ablation in a day surgery setting; 60% were
Objective. To explain the physical principles of microwave endometrial ablation (MEA) whereby a distinction is made between tissue necrosis through
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through the ipsilateral incisions on both sides. The two hammocks were adjusted to hold the vaginal apex in the correct position and tied symmetrically to the edges of the aponeurotic incision. The procedure was successfully completed in all 35 patients without serious complications and no conversions to laparotomy. The women were followed prospectively at 1, 6, and 12 months, and then annually. They responded to a questionnaire during telephone interviews. Objectively, an excellent anatomic result was achieved in 80% of cases (28 patients). Subjectively, 90% of women noted relief of symptoms and improvement in quality of life at last follow-up. Conclusion. This technique was highly effective in treating genital prolapse. 44. Pregnancy after Laparoscopic Myomectomy JB Dubuisson, C Chapron, A Fauconnier, } Deffarges. H6pita[ Baudelocque, Paris, France. Objective. To evaluate pregnancy outcome and risk of uterine rupture after laparoscopic myomectomy (LM). Measurements and Main Results. Among 296 women (age <45 yrs) treated by LM, 98 became pregnant with 100 deliveries ( 145 pregnancies); 58 % delivered vaginally and 42% by cesarean section; 3 uterine ruptures occurred. Only the first rupture (1%) was secondary to LM, another was due to a second operation (laparoscopic-assisted myomectomy) performed elsewhere, and the third to tubouterine implantation. Conclusion. Laparoscopic m y o m e c t o m y requires meticulous technique and excellent repair of the uterine wall. Surgeons must be highly experienced in laparoscopic surgery to limit the risk of uterine rupture. 45. Endometrial Aspiration and Microwave Endometrial Ablation MA El[ard, NC Sharp. Royal United Hospital, Bath, United Kingdom.
Conclusion. Endometrial aspiration is a promising alternative to medical pretreatment, with reduced costs and no side effects, and the ability to obtain an endometrial biopsy specimen. Microwave endometrial ablation can potentially be developed as a one-stop office procedure. 46. Microwave Endometrial Ablation in Women with a Fibroid Uterus MA Ellard, O Hodgson. Royal United Hospital, Bath, United Kingdom. Objective. To describe microwave endometrial ablation (MEA) as an alternative to hysterectomy in treatment of myomas. Measurements and Main Results. Two hundred sixtysix women underwent MEA and completed a minimum of 36 months of follow-up. Fifty-two (19.5%) had uterine myomas, 12 (23.1%) of which distorted the uterine cavity. Fourteen women (26.9%) had more than one myoma on US scan. Of 52 patients with myomas, 82.7% reported satisfaction at 6 months, with 32.7% reporting amenorrhea. This compares with 87.6% satisfaction and 38.3% amenorrhea 6 months for women without myomas. Of 14 patients who required further surgery, 1 had a myoma distorting the cavity and 3 (21.4%) had more than one myoma. Six (10.7%) women went on to have hysterectomy. Conclusion. After MEA, 88% of patients with myomas avoided hysterectomy. Multiple myomas and those causing slight distortion of the uterine cavity do not adversely affect outcome. 47. Analysis of Transcervical Resection of Intrauterine Adhesions for Acquired Synechiae X Enlan, O Hua, F Limin, D Huelan, M Zhang. Fuxing Hospital, Capital University of Medical Sciences, Beijing, Republic of China. Objective. To assess the efficacy and safety of transcervical resection of adhesions (TCRA). Measurements and Main Results. Among 31 women (age 27-46 yrs), 13 had a history of transcervical resection of the endomyometrium, 15 a history of abortion and curettage, and 3 no history of pathology. Indications for surgery were infertility (12), oligomenorrhea (6), dysmenorrhea (9), and amenorrhea (4). Nine women had HSG and all had hysteroscopy. Two adhesions were classified as grade I, eight grade l-I, five grade III, seven grade IV, seven grade Va, and two grade
Objective. To describe endometrial aspiration as an alternative to medical thinning of endometrium. Measurements and Main Results. Patients underwent endometrial aspiration with a 3-mm uterine curette, and microwave endometrial ablation. Mean operating time was 241 seconds (181 sec with medical pretreatment). Most women (92.3%) were satisfied with menstrual outcome, with 46.1% reporting amenorrhea at 6 months. No patients have had further surgery to date.
$13
Abstracts
Vb. The TCRA was performed under B scan with or without laparoscopic monitoring. Mean operating time was 22 minutes and bleeding was minimal. Six patients had hematometra expelled. One woman, the major part of whose uterine cavity was occluded, became pregnant and delivered a normal infant weighing 3550 g. One grade Va uterus was perforated and repaired by laparoscopy. Conclusion. TCRA is safe and effective treatment of acquired intrauterine synechiae. Monitoring with B scan and laparoscopy of difficult cases is recommended.
pretreated. Resection was performed in 65% and rollerball in 35%. Ablation was successful in all patients. Glycine absorption was higher with resection than with rollerball (p = 0.05). Fluid absorption correlated with type of procedure (r = 0.32, p = 0.03) but not with procedure time, uterine size, or pretreatment. With follow-up of 14 _+ 2 months, 95% of patients were satisfied; 80% were amenorrheic and 20% hypomenorrheic. Conclusion. Hysteroscopic endometrial ablation is a safe, effective alternative to hysterectomy in women with large uteri.
48. Transcervical Electroresection of Menorrhagia Combined with Severe Medical Disease X Enlan, O Hua, F Limin, O Huelan, M Zhang. Fuxing Hospital, Capital University of Medical Sciences, Beijing, Republic of China.
50. Transcervical Resection of Submucous Fibroid in a Woman with Thoracocyllosis and Severe Anemia ~C Fang, 1C Qi, 2X Enlan, 2D Zhang, IL Qingchun. ~Panjin Maternal and Child Hospital, Liaoning, Republic of China; 2Fuxing Hospital, Beijing, Republic of China.
Objective. To assess the efficacy and safety of transcervical electroresection of benign uterine lesions for the treatment of menorrhagia combined with severe medical disease, that contraindicated hysterectomy. Measurements and Main Results. In 76 women (age 27-63 yrs) with menorrhagia and severe medical disease (hematophathy, renal failure, cardiac disease, diabetes, hypertension, etc.), we performed resection of endomyometrium (53 cases), polyps (2), or myomas (53) under epidural or intravenous anesthesia. Patients reported improvements in menses and anemia. Two patients died of their medical disorder, one of renal disease and one of heart and respiratory failure. Conclusion. Electroresection of endomyometrium, polyps, or myomas in women with menorrhagia combined with severe medical disease is relatively safe and effective compared with hysterectomy.
Objective. To describe the efficacy and safety of transcervical resection of myomas (TCRM) in a woman with menorrhagia thoracocyllosis and severe anemia. Measurements and Main Results. Because of heavy vaginal bleeding for 2 years, the patient's hemoglobin was 4.4 mg/dl. Her uterus was enlarged to 10 weeks. B scan showed an echo-free mass 6.8 cm in diameter in the uterine cavity. Hysteroscopy showed the uterine cavity to be filled with a single large myoma. Under intravenous anesthesia, the submucous myoma was resected into slices with a resectoscope and removed with ring forceps. The procedure took 130 minutes and was performed with B scan monitoring. Blood loss was about 200 ml. The woman reported no further bleeding at 9-month follow-up visit. Conclusion. For patients with severe medical disease, hysteroscopic surgery is preferred over hysterectomy to treat menorrhagia.
49. Hysteroscopic Endometrial Ablation Is an Effective Alternative to Hysterectomy in Women with Large Uteri ~MA Eskandar, <2GA Vilos, 11Tummon, ~FA Aletebi. ~University of Western Ontario; 2St. Joseph's Health Centre, London, Ontario, Canada.
51. The Physics of Microwave Coagulation, Treatment Dynamics, and Preclinical Testing I Feldberg, N Cronin, M Evans. University of Bath Claverton Downs, Bath, United Kingdom.
Objective. To determine the feasibility, safety, and outcome of hysteroscopic endometrial ablation in women with menorrhagia and large uteri. Measurements and Main Results. Forty-two consecutive women (mean _+SD age 46 _+6 yrs) with a uterus larger than 12 weeks (cavity >10 cm) underwent endometrial ablation in a day surgery setting; 60% were
Objective. To explain the physical principles of microwave endometrial ablation (MEA) whereby a distinction is made between tissue necrosis through
S14